title: The integration of next-generation sequencing panels in the clinical cancer genetics practice: an institutional experience.
abstract: OBJECTIVE
  The advent of next-generation sequencing for cancer susceptibility genes holds promise for clinical genetics application, but the practical issues surrounding integration of this testing into the clinical setting have not been well addressed. This article describes the clinical experience of genetic counselors in an academic and community setting with next-generation sequencing cancer panels.
  
  
  METHODS
  Between April 2012 and January 2013, 60 next-generation sequencing panels were ordered. A retrospective review was conducted to determine the indication for ordering the results of the tests and the patient management based on the results.
  
  
  RESULTS
  Ten tests were canceled due to out-of-pocket costs or previously identified mutations. Among the 50 tests, 5 (10%) showed a positive result. Moreover, 15 of the 50 (30%) panels detected variant(s) of uncertain significance or variant(s) suspected benign.
  
  
  CONCLUSIONS
  We propose clinical guidelines for identifying high-risk patients who should be offered this testing. Our data support the National Comprehensive Cancer Network recommendations that next-generation sequencing be ordered as a second-tier test for high-risk individuals with cancer by trained cancer genetics providers. Literature review and expert knowledge should be used to create management plans for the identification of both positive and variants of uncertain significance results. Providers should be aware of limitations regarding reimbursement for testing and recommended management strategies.
authors.affiliation: Department of Cancer Genetics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Caitlin B
authors.initials: CB
authors.lastname: Mauer
authors.affiliation: Department of Cancer Genetics, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Fort Worth, Texas, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Pirzadeh-Miller
authors.affiliation: Department of Cancer Genetics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Linda D
authors.initials: LD
authors.lastname: Robinson
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Euhus
mesh_terms: D005817:Genetic Counseling; D005820:Genetic Testing; D059014:High-Throughput Nucleotide Sequencing / Q000191:economics* / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis* / Q000235:genetics; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA